Adrenal Cysts: To Operate or Not to Operate?

Abstract

Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease’s rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question–answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.

Endothelial cyst of the adrenal gland: A rare case report

“…The first and most important step in evaluating any adrenal tumor, even cystic ones, is to rule out pheochromocytoma. 16 The current guidelines state that the initial testing for pheochromocytoma includes the biochemical analyses of catecholamine metabolites: urine-fractionated metanephrines or plasma-free metanephrines. Normal biochemical testing, however, does not completely rule out the potential of pheochromocytomas, as up to 30% of individuals could have a non-secretory or a clinically silent pheochromocytoma.…”

Cystic Lesion of the Adrenal Gland: A Case Report

“…Simple cysts are another name for endothelial cysts 14 . With an incidence of 45%, they are the most frequent adrenal cysts in autopsy series, yet they only make up 2% to 24% of lesions that are clinically symptomatic 6 . They fall into two categories: lymphangiomatous and angiomatous 6 .…”

“…With an incidence of 45%, they are the most frequent adrenal cysts in autopsy series, yet they only make up 2% to 24% of lesions that are clinically symptomatic 6 . They fall into two categories: lymphangiomatous and angiomatous 6 . According to research, they can also appear in young people since they are thought to have originated from pre-existing vascular hamartomas 15 .…”

“…Whether to do a minimally invasive or open surgical procedure depends on the surgeon's experience, preferences, and characteristics of the tumor 2 . Surgery is typically recommended for patients with uncertain follow-up, symptomatic cysts of any size, asymptomatic cysts larger than 5 cm, potentially malignant cysts, and functional cysts 6 . Because our patient had pain and lesion was 7 cm, laparoscopic adrenalectomy was performed to remove it.…”

“…These cystic lesions can have serious clinical consequences when they are linked to malignant neoplasms, but they can also resemble benign lesions 5 . Among surgical series, pseudocysts are the most commonly found cystic lesions, while autopsy series reveal that endothelial cysts make up the majority, reaching up to 45% 6 . The majority of adrenal cysts are undiagnosed and asymptomatic.…”